THR Increasing pain 6 months to year post-op

[TBONE]

Stan--Your post is interesting to me because I'm having MOM bilateral THR in 6 days, and in PA. I am not aware of studies or any other information suggesting that MOM is more painful, though I have read that certain, larger and longer implants can cause leg pain in an increased number of patients, and I am aware of concerns with MOM ions building up in individuals. So I am both suspicious of an interested in the comment from your OS. If this was a recommendation from your original OS, I think I would get another opinion.
Nevertheless, I'm comfortable with my decision on MOM and I intend to follow this post to see what others have to say. Best wishes to you.
Tom

 

[Jamie]

Stan, I know it is frustrating to have differing opinions and then try to decide what to do. But, if you are up for it, you might try one other surgeon (independent of the others, of course) just to see if you can get a consensus that would ease your mind about what to do next. I'm reading between the lines of your post, but it sounds like you are worried that if you have a revision done by this newest doctor, what if you go through all of that and it still hurts! That's always a risk, of course, but you might feel better about it if you had more than one surgeon telling you to replace the metal parts.

I do think you shouldn't give up!!! You deserve to have a pain free joint and I still have faith that you can get it!

 

[Josephine]

Okay - you did good and got one opinion. Now get at least two more. It's the only way to do it!

 

[UTdave]

Stan,

Your experienced revision surgeon gives a very interesting perspective. I had some significant groin pain at about the 6 week mark. I had concern about it, but my surgeon and I decided to watch it and he says he has noticed with his transitioning to metal-metal hips that many patients have complained of groin pain, but it has generally resolved at 6 months to a year. Mine has gotten much better over the past two months and is almost gone (actually, it's only present in certain positions, and when I'm in those positions, it's now almost gone).

You got me thinking and I did some quick research. I have found articles delineating metal allergy (or at least immune response to the metal) as a presumed mechanism for the pain. I have seen products and articles suggesting that their design limits how much metal the body is exposed too and, therefore, lowers this problem. I have seen one article describing a neuropathy of the femoral nerve (it sits in the groin) caused by metal wear particles. I suspect that this guy you talked to is right and if you're not making headway revision is necessary. A second or third opinion never hurt anyone, though! It's a big decision to get a revision and I would take all the time your pain will allow getting things researched and lined up.

Have you considered getting allergy tested? May be a moot point by now.

Good luck to you and hang in there!

 

[stant52]

My pain started as an ache back at 4-5 months . It's now at the point after being on my feet for 6 hours or more that once I sit ,when I try to stand the pain is extremely severe,I can not stand to put weight on the leg which I had the THR. I need to stand and wait and then carefully and painfully start to try to walk. It takes maybe 10 minutes or more until I can walk ,gradually looseing the limp and being able to walk fairly normal.
BUt , I never did get a clear explanation as to why the MOM causes this. Just that he has done countless revisions for this problem. I told him my current doctor had used over 30 MOM THR on patients and he hadn't seen any problems. But then 30 is NOTHING. And all in the last year, so no real time to evaluate them.
I come home from work and in just a 5 minute ride in the car and I start to have pain when I go to get out of car. I spent my 30 minute lunch standing today because it takes 10 min. to be able to walk half normal after sitting for lunch. But stand the entire time and no problem. So I stood or walked from 7am until 5:30 pm when I quit work .
Now I just watched TV for an hour and I could hardly get up & walk to the computer.
For the people that would know the facility I just went to is Geisinger Medical Center in Danville Pa. https://www.geisinger.org/
I'm unsure of where else to go ,Pittsburgh or Philadephia are 4 hours travel and I don't have any information on any specialists,I'm not sure all the work would produce any different answers.

 

[Jamie]

Stan, I know it seems like a big burden to have to get second (and maybe third) opinions if you have to go 4 hours away. But it is your future here. I believe the effort will be worth it. You can start with a Google search of revision surgeons in each of those cities and then decide who seems to be a good match for you. At least initiallly, talk to the doctor or his staff on the phone to see if they might be someone you would consider. You need to feel comfortable with the decisions being made about revision surgery and if it takes talking to other doctors, you need to do that.

 

[stant52]

Well I saw a third doctor last week. Another different opinion. He thinks everything looks fine but he doesnt like the choice my doctor made in using a prosthesis with an extra long off-set (on the spike in the femur). He thinks that it is causing the pain though muscle,tendons,ligaments being stretched. But I said it's been 14 months and it seems to be getting worse not better. He says to increase stretching exercises and do more exercises and maybe it will lessen. Or else have the spike replaced with a normal off-set. He does not believe the pain is caused by the MOM . He has used lots of MOM and no problems . He thinks the other specialist is just "old school" thats why he likes the polyeythelene. My doctor is back from vacation this week so I hope to talk to him about the different opinions and pain again.

 

[Tommy Utah]

What jumps out at me here is the physicality of your job. Correct me if I'm wrong but it sounds like the pain started about a month after returning to work. I'd have to say that standing on a concrete floor for 10 hrs a day and often doing some moderate to heavy lifting would have made me sore in some places with a young healthy body. Perhaps the strain of it all is just too much, especially if you remember that your are still in a healing phase even for some time yet. Perhaps another avenue to pursue would be to consult with an Occupational Therapist. While the litany of folks here going back to do remarkable things physically is long and impressive, just as many can probably speak to some limitations or adjustments. Realizing of course that the job itself has parameters that one must fit that you may be locked in to, an OT still might have some suggestions regarding pace, techniques, ergonomics, etc., that might make a difference.

 

[stant52]

Well, I'm back. Here's my old post, https://bonesmart.org/forum/threads/increasing-pain-6-months-to-year-post-op.2470/page-2. Depuy ASR
It's been a while. I decided to try and live with the pain. Start-up pain more then anything. As long as I would stay on it my hip seem fine. Got 4 opinions and they were all so impressed with my terrific range of motion, flexibility that no one would suggest a revision. X-rays, MRI, Blood work , drained fluid off joint (looked good) nothing show any definite cause for the pain. BUT, now the past approx 6 months, maybe more, I notice increased pain when I'm walking, along with the start-up pain.
It gotten to be really a pain to get up from a dinner table and try to walk ! Akward in a restaurant.
So I called the doctor that did my TKR 2 years ago(with absolutely wonderful results!!) he also had looked at my hip and advised that it was up to me. I have an appointment scheduled in 3 weeks and surgury Jan. 28 if we decide to go though with it for a revision. I am going to call tomorrow and get a lab slip to have blood work done before I see him . Check cobalt and chromium levels and . It'd been over a year.
I changed jobs 1 1/2 years ago so I no longer have the physical labor to do at work. Now I'm at a desk or walking around a large garage ,shop for Big trucks, trailers diesels. My hardest job is climbing 3 steps up into a tractor trailer type truck. Sometimes only 2 steps. But walking around the garage from front to bak and across the lot is where I am feeling the afternoon pain in my hip. But I always have the start-up pain ,everywhere,any chair. BUT I don't have any pain getting up from laying down . No problem getting out of bed.
Well thoughtI'd post an up-date ,I ran across this site saved in my favorites. Started me reading everyone elses stories again.

Could have posted in the knee section but my TKR was so wonderful that the therapists warned me not to brag tooo much so that people didn't come to expect theirs to be that good.
I woke up from surgey totaly pain free . And I mean totally . No pain pills and almost full range of motio ! The first day I was told I was at an 8 week level. I was back to work in 8 weeks !! Unloading truck lifting ,carrying 10-50 lb boxes, pulling pallets off trailers . And I have never had a pain in my knee since surgery. Leg is totally straight now ,It was at a bend, angle of 19 degrees inward,knock-knee

 

[Jamie]

Awww, Stan....sorry to hear of your hip pain. I do think you are right to pursue this with a good revision surgeon. You shouldn't have this type of pain and trying to live with it doesn't seem an acceptable solution to me. Best of luck to you and please keep us posted on how things go. I'm sure you'll know a lot more after your appointment in 3 weeks.

 

[C Mac]

Hi Stan,

Welcome back to the forum, sorry it's because you are having ongoing start-up pain. I wonder if you can post any of your x-rays for Josephine to look at, sometimes she is able to see things that are related to pains people complain of. Did they MRI just your hip joint, or can you see the entire stem down the femur? I think I saw that Jo had mentioned possible loosening of something in your other thread -- don't any of the OSs think it could be something like this?

When you say the "start up pain" is that actually in the joint of your hip or further down your femur, or someplace entirely different -- or in various different places at different times?

Great report on your knee, you should share that with the other knee folks if you have a thread over there that's the kind of story that gives hope to others. Let's just hope you can get your hip going in a more positive direction too!!

Take care,
Cardie

 

[Josephine]

Stan, thank you for providing the link to your old thread. I merged the threads and I'm glad I did because I saw some very interesting things .....
1. you have a MoM hip: I also notice that your pain didn't start until 6 months post-op and now has been continuing unabated for 4½ years
2. you have an offset stem: if this was anything to do with your pain, I would have expected there to be some ebb and flow in the history
3. there has never a satisfactory explanation for your pain: this is not uncommon. I've heard many a hip surgeon (at conferences) say that they could find no explanation for a patient's pain so they did a revision anyway and it seemed to resolve the situation. Some would go on to say that they found the reason when they operated, either the implant "just lifted out" despite his conviction that all was well while others asserted they never found anything to explain the patients' symptoms.

1. There has been a lot of concern about MoM in the last couple of years to the extent that a top level conference was called in London . The result of this, as you can read here Metal-on-Metal Hip Replacements: Solving The Uncertainties Dec 2011 and here Metal on Metal warning (old but ongoing news) was that earlier this year the UK National Joint Registry issued a statement to the effect that the use of MoM hips should cease immediately.

Much research is still ongoing of course but it seems as if the problem isn't so much with the metal head (ball) and metal socket but the place where the ball is fitted onto the stem (or spike as you called it). Sometimes, if a surgeon uses a stem from one manufacturer and a ball from another, the fit isn't true so a sleeve is used to resolve that. Unfortunately, this has now been found to be part of the problem, that of introducing a third component into the mix in the highly volatile environment of the human body. It's a mess and a mystery and the full answer has yet to be found. But we do know that an awful lot of people have suffered tissue damage all round the area of that hip as a result. That's one issue.

So some questions regarding this:
- how well do you feel in yourself generally? No unexplained fatigue, minor fevers or anything?
- when did you last have blood tests for metal ions and what was the result?
- when did you last have an MRI scan of the entire pelvic and upper thigh area and what were the findings?
- have you any current xrays you could post for me to have a look at?


2. Regarding the offset stem, these are not usually used vicariously. There has to be a reason the original surgeon used this device but there is always a chance that his reasons were in error or there is some covert loosening.

3. What is unsatisfactory about this is that only one of the surgeons you saw suggested a revision anyway but could only give the vague reason that he 'thought' it was due to the MoM bearing. Well that might be and it might not. But at the end of the day, it seems to me that what you need is a remedial revision, despite there being no discernible reason for your pain. Given the numerous reports from surgeons of quality who have reported doing successful revisions for "idiopathic" pain (meaning cause unknown) it seems to me that this would be a reasonable course of action in your case. And before you get too anxious about it, there would be minimal bone cutting so recovery shouldn't be quite as painful as the first time around.

Well, these are my thoughts on your situation, anyway........

 

[RZRS]

I have not had much time to look at your history, but if you have metal on metal (steel on steel), have you had a simple blood test for Cobalt or Chromium poisoning? That is how they found where my pain was coming from. Mine ate on me for 5 years. Lots of permenant damage has been done.

 

[HappyHippy]

Don't rely on anyone the initial surgeon recommends. Find your own revision specialist independent of your surgeon's network. I have a loose femur that's going to be revised this month - after 3 long years. You don't want to be in pain this long.

I had all the tests and got the runaround because I was working with the first surgeon, then another in the same practice, and one who is supposed to be the best in my State for Anteriors, but he did some training with my surgeon. All were protecting him.

I came here after 2 years in pain and beyond frustrated. The most wonderful Josephine looked at my films and said my femoral stem was loose. Not soon after, the revision specialist I found who was highly rated and from a larger metro area looked at my films and worked me in to tell me I needed a revision, a week or two after Jo did.

And the pain does get worse and worse. I feel like a big baby, but it's taking narcotics to manage the pain, and they're losing effectiveness, since I'm having surgery soon we don't want to raise my tolerance so I have trouble with pain post-op.

Do you have any lucency (space) in your x-rays? I came out of surgery with 2 mm. Bone can't grow into a stem that is sized too small. Go get copies of your tests and digital images that you can upload for Jo to review. Dr's do protect each other and they may make you wait to see if the stem will stabilize. But you can tell now whether there's any chance of that. You have the right to get hard copies of all images and tests, and I've learned to always ask for them.

Good luck to you.

TH

 

[tashia]

I'm so sorry you are having so much problem. Have you read the article on this in the liberary? Keep looking you will find the answer. We are all with you, take care. Keep us posted.
Tashia

 

[HappyHippy]

Stant52,

I'm sorry that I didn't realize I was looking at old threads. I note one said a DePuy ASR. Is that what you have? If so, schedule that revision ASAP and go get your money from DePuy. That hip is in recall and people are receiving medical settlements from all the problems.

I wouldn't hesitate to revise a MoM, as Jo pointed out that they're showing loads of harmful side effects and aren't being used anymore. Sounds like the knee guy may be a good choice for the hip. And as has been said, you can post films here and Jo can advise.

Good luck to you.

TH